Diagnosing ADHD: When do you consider a cognitive trait bad enough to be a disease?

October 29, 2010|By Dr. Jeffrey Kutcher Saturday Columnist

With two months of the school year in the books, parents may now have enough data to fairly assess their child's academic performance.

The painful transition to a new grade level or a new school is over, the chaotic upheaval of social group reshuffling is complete, and new routines are well established.

It is now that parents of children of all ages take a breath, gather the evidence and try to figure where their child fits in the developmental scheme of things.

In most cases, it's business as usual. Some minor bumps in the road, a couple of stumbles here and there, but no real issues.

In others, perhaps as many as 10 percent, a behavioral pattern begins to emerge, manifesting in decreased academic performance. Once a minor nuisance, restlessness and fidgeting begin to interfere with social interactions. Once a subtle trait, a lack of sustained attention dooms productivity.

Attention Deficit Hyperactivity Disorder (ADHD) is the most diagnosed psychiatric disorder in children.

Diagnosing ADHD is rarely a simple matter. The wide range of what can be considered normal brain function means that everybody experiences the symptoms of ADHD to some degree.

Sorting out what may be simple tendencies, as opposed to a pathologic condition, requires evaluation by medical professional.

The difficult question that they must answer is, "When do you consider a cognitive trait bad enough to be a disease?"

This is one reason why ADHD has been a controversial diagnosis over the years.

The other is the widespread use of medications that treat ADHD. There is no doubt that, as a group, patients with ADHD perform better when taking stimulant medications. The problem is that the average person without the ADHD diagnosis will perform better as well.

It's no wonder, then, that we see extremely high rates of non-prescription use of prescription stimulant medications. In one recent survey, 75 percent of college students reported using stimulant medications illicitly to help improve concentration.

Make no mistake, although these medicines can improve cognitive performance, they are not without significant side effects and risks, and should be used only when prescribed by a medical professional.

There is, however, a simple, cheap and effective alternative. Those who are looking to improve concentration in a safe way, whether diagnosed with ADHD or not, can mimic the effects of stimulant medications, raising the levels the neurotransmitters dopamine and norepinephrine in their brain, through exercise.

Again and again, exercise is being shown to provide significant benefit to brain health. In the setting of ADHD, the effects are extraordinary. Although in the majority of ADHD cases exercise cannot completely replace the positive effects of medications, patients will perform better or may even need less medication when getting regular exercise. Three to five days a week, 30 minutes a day of cardiovascular exercise is a great place to start.

If you're concerned that your child may have ADHD, ask their physician for a formal evaluation. In the interim, you may want to have them rake the leaves before doing their homework.

Dr. Jeffrey Kutcher is a graduate of Petoskey High School (1985), Sports Neurologist at the University of Michigan, Director of Michigan NeuroSport and Chair of the Sports Neurology section of the American Academy of Neurology. Learn more at www.med.umich.edu/neurosport.